Vann Sopheap, an ethnic Cambodian who lives in this small border town in Vietnam, prefers the outdoors to the bathroom. “It smells much nicer outside,” he says. “The toilets are too dirty.” Villagers such as Vann are often reluctant to use latrines, a behaviour that contributes to the prevalence of diarrhoeal diseases in Vietnam, which can sometimes become deadly, especially for children under-five.

According to the UN, some 10 million people in Vietnam continue to practise open defecation. Each year more than 20,000 people die in the country because of a lack of clean water, poor sanitation and hygiene, the World Health Organization (WHO) reports.

 

A woman paddles her boat along the Mekong River. Water and sanitation issues remain a key challenge in Vietnam. (Credit: Tharum Bun/IRIN)

 

Sanitation lags behind other MDGs

In the past two decades, speedy economic growth and efficient government policies have led to “considerable gains” in child health, Lotta Sylwander, the country representative for the UN Children's Fund (UNICEF), recently told government officials and international donors in the capital, Hanoi.

The country has achieved almost all the Millennium Development Goals (MDGs) “well ahead of schedule”, making it a leader among many Asian countries, reveals a report published by UNICEF in September. But progress in sanitation has been slow.

In 2006, the latest year for which data is available, just over half of the rural population had access to “improved” sanitation facilities, as did 88% of the urban population, according to UNICEF.

Twenty million children, or 59% of all children in Vietnam, do not have access to proper sanitation. About 73% of schools have latrines, but fewer than half meet national standards.

Twenty million children, or 59% of all children in Vietnam, do not have access to proper sanitation. About 73% of schools have latrines, but fewer than half meet national standards. A lack of access to clean sanitation and hygiene causes about half of all communicable diseases in the country.

“Poverty can be one reason for this, but education and culture play very important roles as well,” Thowai Zai, head of the UNICEF water and sanitation programme, told IRIN.

Many people living in rural and remote mountainous areas consider open defecation to be cleaner, he said. In poor areas, especially in northern mountainous regions and the central highlands, people have much scarcer access to toilets, Zai added.

Others defecate in rivers and ponds, the same water sources they use for cooking, cleaning and bathing.

Some experts argue that NGOs need to more effectively educate villagers. “Villagers know it's no good to poop into the water,” Jack Sim, founder of the World Toilet Organisation, told IRIN from Singapore.

“The only thing needed is to reinforce that message, because old habits take time to change,” he added.

 

Community approach

Merely providing toilets does not guarantee local people will use them, experts say. To encourage more efficient use of latrines and good hygiene, in 2009 the Ministry of Health introduced a programme called community-led total sanitation (CLTS), in several poor provinces throughout the country, such as Dien Bien, Lao Cai, Kon Tum, Ninh Thuan, and An Giang. Rather than NGOs subsidizing the construction of individual toilets for each household, the project attempts to mobilise communities to analyse their own sanitation problems and agree on their own solutions.

UNICEF hopes the villages can become “open-defecation-free”.

Earlier this year, the Asian Development Bank (ADB) approved a US$45 million loan for a large water supply and sanitation project in six central Vietnamese provinces.

The loan will be used to improve toilets in schools, hospitals and homes. About 350,000 people will reap the benefits, according to the ADB, which hopes the project will be completed by 2016.

 

This post was originally published in IRIN in October 2010.

 

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